P1066: OUTCOMES OF COVID-19 IN PATIENTS WITH MYELOPROLIFERATIVE NEOPLASMS - AN OBSERVATIONAL COHORT STUDY FROM A LARGE ACADEMIC CANCER CENTER IN THE UNITED STATES
Authors: S. Venugopal, H. Song, C. Young, M. A. Cutherell, J. A. Baganz, S. Zatorsky, S. E. Woodman, N. Pemmaraju, P. Bose, L. Masarova, L. Zhou, S. Pierce, H. Kantarjian, S. Verstovsek
Journal: HemaSphere (2022)

Background: Infections are one of the main causes of morbidity and mortality in patients with Myeloproliferative Neoplasms (MPN). Several studies from all over the world has reported on outcomes of the SARS-CoV-2 infection (COVID-19) pandemic in MPN pts but there is no robust data on characterizing the clinical outcomes of patients with MPN and COVID-19 in the United States (US). Aims: Therefore, we aimed to investigate the effect of COVID-19 on MPN patients’ clinical outcomes including the effect of MPN-subtypes, and SARS-CoV-2 vaccination on COVID-19 infection. Methods: We conducted a single center, retrospective, observational cohort study. Between April 2020 – December 2021, data was obtained from 388 patients flagged in the electronic health records system with MPN and COVID-19, of which 53 MPN patients with positive SARS-CoV-2 test were identified. COVID-19 infection was ascertained by a positive real-time reverse transcriptase polymerase chain reaction from nasal swab. Presenting clinical information was abstracted from review of unstructured notes as well as structured data from the foundry. Demographic and baseline parameters were summarized. The Kaplan-Meier method was utilized to compare the median time from date of diagnosis to date of last follow up or death. Results: Among 53 patients with MPN and COVID-19 infection, the median age was 58 yrs (range,21-83) with equal distribution between men and women of which 46% had a body mass index ≥30. Most common comorbidities included hypertension (60%), and diabetes (19%). 17 (33%) patients required hospitalization of which all (33%) of them required oxygen supplementation. 12 pts (23%) had radiological evidence of pneumonia of which 4 pts (8%) required high flow oxygen and 3 pts (6%) required mechanical ventilation. 2 pts had new thrombosis of portal vein and coronary artery each. 10 pts (19%) received remdesivir and 4 (8%) received tocilizumab, and 9 pts (17%) received steroids. At a median follow up of 11.8 months, 7 pts died at a median of 24 days after COVID-19 diagnosis and the case fatality rate was 13%. Except for 1 pt,all the other 6 pts who died had BMI≥30. In the US, COVID-19 predominantly occurred in pts with myelofibrosis (56%), polycythemia vera (29%), and essential thrombocythemia (15%). 54% received MPN directed therapy of which 17 (33%) pts received ruxolitinib, and 11 pts (21%) received hydroxyurea. At the time of infection, median WBC was 6.2 x 109/µL (range,0.3-16.3),Hb was 11.6 gm/dL (range,6.8-15.8),platelet count was 178 x 109/µL (range,2-766), and the median neutrophil to lymphocyte ratio was 4.1. In this cohort, 22 pts (42%) were infected prior to the availability of vaccination. 42% of the entire cohort has received vaccination of which 45% pts were infected after first dose of vaccination. Among the 7 deaths, 6 patients had underlying myelofibrosis, and one pt had polycythemia vera, and all deaths occurred in unvaccinated population except for one death that occurred post vaccination. Hospitalization rate was higher in the unvaccinated (33%) pts than those who were vaccinated (22%). Summary/Conclusion: To date this is the largest cohort of MPN patients with COVID-19 infection in the US accounting for 14% of the MPN patients with COVID-19 in our center. BMI≥30 appear to be an important risk factor for COVID-19 infection and mortality in MPN pts. SARSCOV2-vaccination appear to decrease the risk of mortality and hospitalization. Patterns of inflammatory markers, and long term follow up of recovered MPN pts with COVID-19 will be presented in the meeting.